# US 11,432,868 B2 · Ultrasonic surgical instrument with electrosurgical feature > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 11,432,868 B2 - Document ID: US11432868B2 - Status: Granted - Kind: B2 - Application number: 15/910,271 - Filed: 2018-03-02 - Published: 2018-09-13 - Granted: 2022-09-06 - Earliest claimed: 2013-11-21 - Assignees: Cilag GmbH International - Applicants: Cilag GmbH International - Inventors: Daniel W. Price; Benjamin D. Dickerson - Web page: https://patentgrep.com/patent/US11432868B2 ## CPC - A61B 18/1445: {at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod} - A61B 2017/00022: {Sensing or detecting at the treatment site} - A61B 2017/00026: {Conductivity or impedance, e.g. of tissue} - A61B 2017/00039: {Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect} - A61B 2017/320069: {for ablating tissue} - A61B 2017/320071: {with articulating means for working tip} - A61B 2017/320089: {node location} - A61B 2017/320094: {additional movable means performing clamping operation} - A61B 2017/320095: {with sealing or cauterizing means} - A61B 2018/00642: {with feedback, i.e. closed loop control} - A61B 2018/00875: {Resistance or impedance} - A61B 2090/064: {for measuring force, pressure or mechanical tension} - A61B 2090/067: {for measuring angles} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract A surgical instrument system includes an end effector, a generator, and a controller. The end effector includes an ultrasonic blade and at least one electrode surface. The generator provides power to the end effector. The end effector applies ultrasonic energy to tissue via the blade or RF energy to tissue via the at least one electrode surface. The controller is configured to select between one or both of ultrasonic energy or RF energy, and thereby control the generator to provide the selected one or both of ultrasonic energy or RF energy at the end effector, based on a sensed operating condition of the end effector. The controller may select between ultrasonic energy and RF energy based on whether a clamp arm is in an open position relative to the blade, based on which button is being activated, and based on whether tissue is sensed at the end effector. ## Claims ### Claim 1 A method of treating tissue with a surgical system, wherein the surgical system comprises a surgical instrument having an end effector that includes an ultrasonic blade, a clamp arm, a controller, and at least one electrode, the method comprising: (a) capturing tissue between the clamp arm and the ultrasonic blade; (b) activating the ultrasonic blade with ultrasonic energy sufficient to cut the captured tissue; (c) activating the at least one electrode with RF energy sufficient to seal the captured tissue; and (d) automatically determining with the controller to activate the ultrasonic blade or the at least one electrode in response to sensing a presence of tissue at the end effector, wherein sensing a presence of tissue at the end effector comprises measuring an impedance level at the at least one electrode. ### Claim 2 (depends on 1) The method of claim 1, wherein the at least one electrode comprises a first electrode and a second electrode, wherein activating the at least one electrode with RF energy comprises activating the first and second electrodes with bipolar RF energy. ### Claim 3 (depends on 2) The method of claim 2, wherein the first electrode is provided by the ultrasonic blade and the second electrode is provided by the clamp arm. ### Claim 4 (depends on 1) The method of claim 1, wherein the surgical instrument further comprises a first actuator and a second actuator, wherein the method further comprises: (a) activating the ultrasonic blade with ultrasonic energy in response to actuation of the first actuator; and (b) activating the at least one electrode with RF energy in response to actuation of the second actuator. ### Claim 5 (depends on 1) The method of claim 1, wherein the surgical instrument further comprises at least one actuator, wherein the automatic determination is made by the controller in response to actuation of the at least one actuator. ### Claim 6 (depends on 5) The method of claim 5, wherein the at least one actuator comprises a first actuator and a second actuator, wherein the automatic determination is made by the controller in response to actuation of at least one of the first actuator or the second actuator. ### Claim 7 (depends on 1) The method of claim 1, wherein the automatic determination is made by the controller based on sensing at least one of: (i) a presence of tissue at the end effector, (ii) a position of the clamp arm relative to the ultrasonic blade, or (iii) actuation of an actuator of the surgical instrument. ### Claim 8 (depends on 7) The method of claim 7, wherein the surgical instrument further comprises a trigger operable to actuate the clamp arm, wherein the automatic determination is made by the controller in response to sensing a presence of tissue at the end effector, wherein sensing a presence of tissue at the end effector comprises measuring a force exerted on the trigger by a user. ### Claim 9 (depends on 7) The method of claim 7, wherein the automatic determination is made by the controller based on sensing actuation of an actuator of the surgical instrument and sensing at least one of: (i) a presence of tissue at the end effector, or (ii) a position of the clamp arm relative to the ultrasonic blade. ### Claim 10 (depends on 1) The method of claim 1, wherein the automatic determination made by the controller comprises one of: (i) activating the ultrasonic blade with continuous or pulsed ultrasonic energy, or (ii) activating the at least one electrode with continuous or pulsed RF energy. ### Claim 11 (depends on 1) The method of claim 1, wherein the automatic determination made by the controller comprises: (i) for a first period, activating the at least one electrode with RF energy, (ii) for a second period, activating the ultrasonic blade with a first level of ultrasonic energy, and (iii) for a third period, activating the ultrasonic blade with a second level of ultrasonic energy. ### Claim 12 (depends on 1) The method of claim 1, wherein the automatic determination made by the controller comprises activating the at least one electrode with RF energy and activating the ultrasonic blade with ultrasonic energy in an alternating manner. ### Claim 13 (depends on 1) The method of claim 1, wherein the automatic determination made by the controller comprises: (i) for a first period, activating the at least one electrode with a first level of RF energy, (ii) for a second period, activating the ultrasonic blade with ultrasonic energy, and (iii) for a third period, activating the at least one electrode with a second level of RF energy. ### Claim 14 A method of treating tissue with a surgical system, wherein the surgical system comprises a surgical instrument having an actuator and an end effector that includes an ultrasonic blade, a clamp arm, and an electrode, the method comprising: (a) capturing tissue between the clamp arm and the ultrasonic blade; (b) sensing a condition at the end effector; and (c) in response to actuation of the actuator and based on the sensed condition, automatically activating the ultrasonic blade with ultrasonic energy sufficient to cut the captured tissue and activating the electrode with RF energy sufficient to seal the captured tissue. ### Claim 15 (depends on 14) The method of claim 14, wherein sensing a condition at the end effector comprises sensing at least one of: (i) a presence of tissue at the end effector, or (ii) a position of the clamp arm relative to the ultrasonic blade. ### Claim 16 (depends on 14) The method of claim 14, wherein automatically activating at least one of the ultrasonic blade or the electrode comprises activating the ultrasonic blade with ultrasonic energy sufficient to cut the captured tissue followed by activating the electrode with RF energy sufficient to seal the captured tissue. ### Claim 17 A method of treating tissue with a surgical system, wherein the surgical system comprises a surgical instrument having an actuator and an end effector that includes an ultrasonic blade, a clamp arm, and an electrode, the method comprising: (a) capturing tissue between the clamp arm and the ultrasonic blade; (b) activating the ultrasonic blade with ultrasonic energy sufficient to cut the tissue; (c) measuring an impedance level of the tissue at the electrode; and (d) based on the measured impedance level, automatically: (i) ceasing activation of the ultrasonic blade with ultrasonic energy, and (ii) activating the electrode with RF energy sufficient to seal the tissue. ### Claim 18 (depends on 17) The method of claim 17, wherein the electrode comprises a first electrode, wherein the end effector further comprises a second electrode, wherein activating the electrode with RF energy sufficient to seal the tissue comprises activating the first and second electrodes with bipolar RF energy.